Obstetric fistula is a complication of pregnancy that affects women following prolonged obstructed labour. Although there have been achievements in the surgical treatment of obstetric fistula, the long-term emotional, psychological, social and economic experiences of women after surgical repair have received less attention. This paper documents the challenges faced by women following corrective surgery and discusses their needs within the broader context of women's health. We interviewed a small sample of women in West Pokot, Kenya, during a two-month period in 2010, including eight in-depth interviews with fistula survivors and two focus group discussions, one each with fistula survivors and community members. The women reported continuing problems following corrective surgery, including separation and divorce, infertility, stigma, isolation, shame, reduced sense of worth, psychological trauma, misperceptions of others, and unemployment. Programmes focusing on the needs of the women should address their social, economic and psychological needs, and include their husbands, families and the community at large as key actors. Nonetheless, a weak health system, poor infrastructure, lack of focus, few resources and weak political emphasis on women's reproductive health do not currently offer enough support for an already disempowered group.

BackgroundObstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women’s health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing?MethodsWe used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients.ResultsWe recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms.ConclusionsWe conclude that the formal health system is not responsive to women’s needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women’s treatment pathways.Electronic supplementary materialThe online version of this article (10.1186/s12905-017-0451-6) contains supplementary material, which is available to authorized users.

Doctoral training has increasingly become the requirement for faculty in institutions of higher learning in Africa. Africa, however, still lacks sufficient capacity to conduct research, with just 1.4% of all published research authored by African researchers. Similarly, women in Sub-Saharan Africa only constitute 30% of the continent’s researchers, and correspondingly publish little research. Challenging these gendered inequities requires a gender responsive doctoral program that caters for women’s gender roles that likely affect their enrollment in, and completion of, doctoral programs. In this article, we describe a public and population health multidisciplinary doctoral training program – CARTA and its approach to supporting women. This has resulted in women’s enrollment in the program equaling men’s and similar throughput rates. CARTA has achieved this by meeting women’s practical needs around childbearing and childrearing and we argue that this has produced some outcomes that challenge gender norms, such as fathers being child minders in support of their wives and creating visible female role models.

Background: There are low levels of research productivity among Higher Education Institutions (HEIs) in Africa, a situation that is likely to compromise the development agenda of the continent if not addressed. We conducted a systematic literature review to determine the factors associated with research productivity in HEIs in Africa and the researchers’ motives for research. Methods: We identified 838 papers related to research productivity in HEIs in Africa from various databases, from which we included 28 publications for review. The inclusion criteria were that (i) the paper’s primary focus was on factors associated with research productivity; (ii) the setting was on the higher education institutions in Africa; (iii) the type of publication was peer-reviewed papers and book chapters based on primary or secondary data analysis; and (iv) the language was English or French. Essays, opinions, blogs, editorials, reviews, and commentaries were excluded. Results: Most of the studies operationalized research productivity as either journal publications or conference proceedings. Both institutional and individual factors are associated with the level of research productivity in HEIs in Africa. Institutional factors include the availability of research funding, level of institutional networking, and the degree of research collaborations, while individual factors include personal motivation, academic qualifications, and research self-efficacy. Conclusions: Deliberate efforts in HEIs in Africa that addressed both individual and institutional barriers to research productivity are promising. This study recommends that the leadership of HEIs in Africa prioritizes the funding of research to enable researchers to contribute to the development agenda of the continent. Moreover, HEIs should build institutional support to research through the provision of research enabling environments, policies and incentives; strengthening of researchers’ capabilities through relevant training courses, mentorship and coaching; and embracing networking and collaboration opportunities.

Background: There are low levels of research productivity among Higher Education Institutions (HEIs) in Africa, a situation that is likely to compromise the development agenda of the continent if not addressed. We conducted a systematic literature review to synthesize evidence of the factors associated with research productivity in HEIs in Africa and the researchers’ motives for research. Methods: We identified 838 publications related to research productivity in HEIs in Africa from various databases, from which we included 28 papers for review. The inclusion criteria were that (i) the paper’s primary focus was on factors associated with research productivity, and motivations of doing research among faculty members in Africa; (ii) the setting was the HEIs in Africa; (iii) the type of publication was peer-reviewed papers and book chapters based on primary or secondary data analysis; and (iv) the language was English or French. Essays, opinions, blogs, editorials, reviews, and commentaries were excluded. Results: Most of the studies operationalized research productivity as either journal publications or conference proceedings. Both institutional and individual factors are associated with the level of research productivity in HEIs in Africa. Institutional factors include the availability of research funding, level of institutional networking, and the degree of research collaborations, while individual factors include personal motivation, academic qualifications, and research self-efficacy. Conclusions: Deliberate efforts in HEIs in Africa that addressed both individual and institutional barriers to research productivity are promising. This study recommends that the leadership of HEIs in Africa prioritizes the funding of research to enable researchers to contribute to the development agenda of the continent. Moreover, HEIs should build institutional support to research through the provision of research enabling environment, policies and incentives; strengthening of researchers’ capabilities through relevant training courses, mentorship and coaching; and embracing networking and collaboration opportunities.